<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
	<head>
		<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
		<meta http-equiv="X-UA-Compatible" content="IE=8" />
			<title><!--%nom_fonction%--></title>
			<link rel="stylesheet" type="text/css" href="../../css/main.css" />
            <link rel="stylesheet" type="text/css" href="<!--%css_module%-->" />

			    <!--[if IE 7]>
            	<link rel="stylesheet" type="text/css" href="../css/ie7.css" />
            	<link rel="stylesheet" type="text/css" href="form_ie7.css" />
            <![endif]-->
            
            
	</head>
	<body>
		<div id="sf_menu1">
			<h3><!--%nom_module%--></h3>
			<div id="information_erreur" >
	        		<ul id="message">
	        			<!--%loop:messages%-->
	        			<li><!--%message%--></li>
	        			<!--%endLoop:messages%-->
	        		</ul>
			</div>
		</div>
		
		<div class="corps1">
	
			<div class="cleared"></div>
			<div id="br"></div>
			<div class="imgleft"></div>
			<div class="imgmiddle">
				<div class="btn">
	        	<span class="btnleft"></span>
	            <span class="btnmiddle"><h5><!--%nom_fonction%--></h5></span>
	            <span class="btnright"></span>
	        </div>
			<div class="btn1">
	        	<span class="btnleft"></span>
	            <span class="btnmiddle"><h5><!--%nom_liste%--></h5></span>
	            <span class="btnright"></span>
	        </div>
	        
				<div class="cleared"></div>
				<div id="br"></div>
				<form action="<!--%edit_action%-->" method="post" name="form1" id="form1">
					<div class="formulaire">
						  <div class="bt1check">
						  <span>DOSSIER A TRANSMETTRE A L'ASSUREUR POUR INSTRUCTION&nbsp;&nbsp;&nbsp;&nbsp;</span>
							<input type="checkbox" name="synthese" id="synthese" value="" <!--%checked%--> /> 
						  </div>
						  <div class="cleared"></div>
						  <div id="br"></div>
						 <div class="bt1check">
						 <span style="width:200px;">IL MANQUE DES PIECES POUR TRANSMETTRE LE DOSSIER&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span>
						 <input type="checkbox" name="synthese" id="synthese" value="" <!--%checked1%--> />
						 </div>
					</div>			
				</form>
			</div>
			<div class="imgright"></div>
			<div class="cleared"></div>

					<div class="bt1 retour">
						<a href="<!--%url_Retour%-->">
		    			<span class="btleft"></span><span class="btmiddle">Retour</span><span class="btright"></span>
		    			</a>
					</div>	
	        	
	                <div class="bt1">
						<a  href="<!--%url_pieces_manquantes%-->">
					    	<span class="btleft"></span>
					        <span class="btmiddle">Pi&egrave;ces manquantes</span>
					        <span class="btright"></span>
					    </a>
					</div>    

		</div>
	</body>
	
</html>
